Deep sclerectomy with supraciliary hema implant (Esnoper (R) V-2000): results and complications

Abstract

The aim was to report the results of deep sclerectomy (DS) with supraciliary hema implant and the influence of the surgical complications on intraocular pressure (IOP). Forty-eight eyes of 41 patients with open angle glaucoma (OAG), who underwent DS with supraciliary hema implant (Esnoper(A (R)) V-2000), were included in this study. A significant IOP reduction was observed, changing from a preoperative mean of 24.6 +/- A 6.33 mmHg to 16.5 +/- A 4.4 mmHg (p < 0.001) at 12 months and 16.1 +/- A 3.4 mmHg (p < 0.001), at 24 months. Similarly, a significant reduction in the number of glaucoma drugs needed was observed, varying from 2.71 to 0.22 (p < 0.001) and 0.4 (p < 0.001), 1 and 2 years after surgery. Goniopuncture with the Nd:Yag Laser was performed in 30 eyes (62.5 %) with a mean time between the surgery and the procedure of 150 days, producing a mean IOP reduction of 4.0 mmHg (p < 0.001). The main intraoperative complications were microperforation of the trabeculodescemetic membrane (TDM) in 1 eye (2.08 %) The main early postoperative complications were seidel at 24 h in 11 eyes (22.91 %), hyphema in 7 eyes (14.58 %), choroidal detachment in 3 eyes (6.25 %) with macular folds in 2 (4.16 %) and need for additional mitomycin injections in 2 eyes (4.16 %). All these complications were spontaneously resolved. No correlation between these complications and final IOP was found, but a significant correlation between the presence of hyphema and higher IOP 24 months postoperatively (p = 0.048) was observed. DS with supraciliary hema implant is a safe and effective technique for the management of OAG. The presence of hyphema during the first week after the surgery could be considered as a negative prognostic factor in DS with supraciliary implantation.